Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun 18;15(6):e40595.
doi: 10.7759/cureus.40595. eCollection 2023 Jun.

Complications and Costs Associated With Ethnicity Following Total Hip Arthroplasty: A Retrospective Matched Cohort Study

Vikram A Aggarwal  1 , Garrett Sohn  1 , Sharon Walton  1 , Senthil Sambandam  1 , Dane Wukich  1
Affiliations

Complications and Costs Associated With Ethnicity Following Total Hip Arthroplasty: A Retrospective Matched Cohort Study

Vikram A Aggarwal et al. Cureus. .

Abstract

Background: Minority patients often have greater numbers of complications, revisions, and costs after total hip arthroplasty (THA). This study investigates how race correlates with specific surgical complications, revisions, and total costs following THA both before and after propensity matching.

Methods: Data from 2014-2016 were collected from a large commercial insurance database known as PearlDiver. THA patients were assigned under Current Procedural Terminology (CPT-27130) and International Statistical Classification of Diseases (ICD-9-P-8151) codes and then divided into groups based on racial status in the database. Patients of different ethnicities including White, Black, Asian, and Hispanic patients were compared in regard to age, gender, comorbidities, lengths of stay, and surgical complications and costs at thirty days, ninety days, and one year using unequal variance t-tests. Black, Asian, and Hispanic patients are collectively referred to as minority patients. Patient comparisons were done both before and after matching for age, gender, tobacco use, diabetes, and obesity comorbidities.

Results: A total of 73,688 White (93%), 4,822 Black (6%), 268 Asian (0.3%), and 420 Hispanic (0.5%) THA patients were included. Significantly more minority patients underwent THA under the age of 65 and had higher comorbidity indices and lengths of stay. Black patients had significantly higher complication rates, but there was no significant difference in rates of revision in any minority group. Minority patients were charged 9%-83% more. After matching, Black and Hispanic patients maintained higher comorbidity indices and lengths of stay. Black patients had a spectrum of complication rates but significantly decreased revision rates. Furthermore, after matching, minority patients were charged 5%-65% more.

Conclusions: Black patients experienced significantly greater rates of complications and higher total costs; whereas, Asian and Hispanic patients did not have significant differences in complications but did have higher costs. Therefore, this study aligns with previous studies and supports our hypothesis that Black ethnicity patients have worse outcomes than White ethnicity patients after THA, advocating for reducing health disparities and establishing more equitable healthcare, but does not support our hypothesis for Asian and Hispanic patients, likely due to a small study population size, warranting further research into the topic.

Keywords: complications; healthcare costs; race inequities; retrospective cohort; total hip athroplasty.

PubMed Disclaimer

Conflict of interest statement

The authors have declared financial relationships, which are detailed in the next section.

Figures

Figure 1
Figure 1. Patient Collection Schematic for Comparing White and Black Patients
THA: total hip arthroplasty
Figure 2
Figure 2. Patient Collection Schematic for Comparing White and Asian Patients
THA: total hip arthroplasty
Figure 3
Figure 3. Patient Collection Schematic for Comparing White and Hispanic Patients
THA: total hip arthroplasty
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. Sloan M, Premkumar A, Sheth NP. J Bone Joint Surg Am. 2018;100:1455–1460. - PubMed
    1. Patient-reported quality of life after primary major joint arthroplasty: a prospective comparison of hip and knee arthroplasty. Dailiana ZH, Papakostidou I, Varitimidis S, et al. BMC Musculoskelet Disord. 2015;16:366. - PMC - PubMed
    1. Disparities across diverse populations in the health and treatment of patients with osteoarthritis. Faison WE, Harrell PG, Semel D. Healthcare (Basel) 2021;9:1421. - PMC - PubMed
    1. Persistent racial disparities in utilization rates and perioperative metrics in total joint arthroplasty in the U.S.: a comprehensive analysis of trends from 2006 to 2015. Amen TB, Varady NH, Rajaee S, Chen AF. J Bone Joint Surg Am. 2020;102:811–820. - PubMed
    1. Variations in postoperative complications according to race, ethnicity, and sex in older adults. Brooks Carthon JM, Jarrín O, Sloane D, Kutney-Lee A. J Am Geriatr Soc. 2013;61:1499–1507. - PMC - PubMed

LinkOut - more resources